Advances in Contemporary Mental Health Nursing: A Continuous Process
Barbara E Wolfe
Professor, William F Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, United States of America
PP: 160 - 162
Article Text
It's not the progress I mind, it's the change I don't like.
Mark Twain
In this special issue of Contemporary Nurse (Advances in Contemporary Mental Health Nursing (ISBN 0-9750436-8-4), articles highlight the ever-increasing complexity of today's healthcare arena, and the growing contributions toward an increased understanding of mental health nursing practice. As a collection, these scholarly contributions challenge us to continually re-examine our practice and strive for excellence in areas we can improve. Two thematic areas of significant importance include attention to the
- Ever-changing factors influencing delivery of mental health nursing care, and
- knowledge developments that support or refute conventional practice.
Factors Influencing Mental Health Nursing Care
Readers are challenged to think about a number of critical questions pertaining to the delivery of mental health nursing care that, at times, might seem provocative or yet, at other times, uncomfortable departures from the status quo. For example, Wand and Schaecken's article 'Consumer Evaluation of a Mental Health Liaison Nurse Service in the Emergency Department' forces us to ask the pointed questions- how do consumer's evaluate our practice?-and are we doing as well as we think we are? Interestingly, these are questions to ask ourselves irrespective of practice setting and populations served. While one could argue that perceptions may differ from reality, an increased understanding of such perceptions provides key information as to the extent to which the consumer has experienced unmet needs (e.g. understanding discharge and follow-up care directions) that potentially influence their wellbeing. Other pertinent information may emerge, including the value the consumer assigns to the therapeutic relationship and the extent to which this fluctuates with time, type of situation, setting or different phases of care. Similarly, understanding the nurse's perception provides an index of congruence between perceived care and objective measures of actual care, pointing to possible areas for improved or refined skills.
Another critical area necessitating greater reflection is the influence of both changing and longstanding beliefs and values, held by individuals and their societies, which affect the delivery of mental health care. Disparities in mental health services (eg access, type, frequency) can occur, for example, when race, ethnicity and socio-economic status impact the availability, utilization and cost of these services (Barrio et al. 2003; Herbeck et al. 2004; Husaini et al. 2003). This is eloquently illustrated by O'Brien in his paper 'Moving Toward Culturally Sensitive Services for Indigenous People: A Non-Aboriginal Mental Health Nursing Perspective'.
Yet, a different twist on the influence of beliefs and values is offered in the paper 'Attitudes of Registered Psychiatric Nurses Towards Patients Diagnosed with Borderline Personality Disorder' by Deans and Meocevic. This article causes one to pause and ask what factors contribute to negative attitudes held by professionals toward individuals given a particular diagnostic label. Is it an issue of countertransference? Is it stigma? Is it related to knowledge deficits about the disorder and its treatment? Is it a reflection of coping with the care and management of persistent and difficult behavioral response patterns? Is it all, some, or none of the above? Future follow-up studies of the etiologic nature of these attributes will be of critical importance in developing and testing novel interventions to help clinicians better manage such situations. Once contributory factors are elucidated, targeted strategies can be formulated and tested with the aim of providing more effective means in working with these individuals. Improved strategies have the potential to reduce healthcare disparities and stigmatization of vulnerable populations.
Another, nonetheless compelling, matter is the need to devise novel settings for the delivery of mental health care as well as those services that go beyond traditional treatment, rehabilitation, and preventative services. Is mental health nursing care provided in settings that maximize accessibility and minimize stigma? What is it about our current health care structures that inhibit access to, or continuity of, mental health care? What alternative models might be developed? As illustrated in Barkway's article 'Creating Supportive Environments for Mental Health Promotion in the Workplace', health promotion may play a key role in contemporary health care systems with an increased focus on wellness in addition to the conventional focus on illness.
Contemporary Practice: What is the Evidence?
How do we know that we are practicing 'contemporary' practice? In part this relies on professional responsibility for keeping up to date on knowledge developments in the field. In Carper's classic article (1978), she distinguishes four fundamental patterns of 'knowing' which include
- empirics (the science),
- aesthetics (the art),
- personal knowledge (reflexive), and
- ethics (moral knowledge).
She notes that these patterns of knowing are not mutually exclusive and, when examined alone, prove insufficient. Rather, in concert they provide a more meaningful approach to the development of knowledge for nursing.
In this issue, we have seen exemplary models of advancing knowledge for mental health nursing practice using these patterns of knowing. For example, Horowitz et al. describe the use of a research-based screening for enhanced detection of post-partum depression. Thus, early discovery may mean earlier treatment and potentially reduced burden and cost of illness. Using a literature review approach, Lanza and colleagues critically evaluate what is known about violence against psychiatric nurses, noting the paucity of data available on the emotional impact. Without such data, advances in interventions for these nurses remain difficult and thus point to the importance of further study. Based on a critical evaluation of the literature as well as a review of ethical considerations pertaining to coercion, McKenna and colleagues offer 'Best Practice Strategies' for mental health nurses during the clinical application of civil commitment. Specifically, they highlight the use of principles of justice to address concerns of coercion and improve outcomes.
However, 'knowing' in itself is not enough to bring about excellence in contemporary mental health nursing practice. The need for continuous professional development targeted at the translation and integration of knowledge into practice is essential. This is not prescriptive, but rather a process- constantly evolving and influenced by one's level of role development. Benner's description 'From Novice to Expert' nicely illustrates how expert integration of knowledge fosters excellence and power in clinical practice (1984). Through this process, one recognizes that it is unremitting - 'knowledge is subject to change and revision' (Carper 1978: 23).
Summary
The strive for excellence in mental health nursing practice is a continuously evolving process-what was excellent yesterday, has often been improved with new knowledge of today. The rapid scientific and technological developments provide many answers to previous problems. However, they too bring about new challenges requiring us to ceaselessly re-examine our practice, develop new theories, and find innovative ways to improve. As captured by Albert Einstein - 'The significant problems we face today cannot be solved at the same level of thinking we were at when we created them.' It is therefore essential that we enthusiastically welcome opportunities to promote knowledge development and its appropriate translation and integration into practice to enhance innovative advances in contemporary mental health nursing.
References
Barrio C, Yamada AM, Hough RL, Hawthorne W, Garcia P and Jeste DV (2003) Ethnic disparities in use of public mental health case management services among patients with schizophrenia. Psychiatric Services 54: 1264-1270.
Benner P (1984) From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison-Wesley Publishing Co: Menlo Park, California.
Carper BA (1978) Fundamental patterns of knowing in nursing. Advances in Nursing Science 1: 13-23.
Herbeck DM, West JC, Ruditis I, Duffy FF, Fitek DJ, Bell CC and Snowden LR (2004) Variations in use of second-generation antipsychotic medication by race among adult psychiatric patients. Psychiatric Services 55: 677-684.
Husaini BA, Sherkat DE, Moonis M, Levine R, Holzer C and Cain VA (2003) Racial differences in the diagnosis of dementia and in its effects on the use and costs of health care services. Psychiatric Services 54: 92-96.
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